Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study

Abstract

Background Early and accurate identification of septic patients at high risk for ICU mortality can help clinicians make optimal clinical decisions and improve the patients’ outcomes. This study aimed to develop and validate (internally and externally) a mortality prediction score for sepsis following admission in the ICU. Methods We extracted data retrospectively regarding adult septic patients from one teaching hospital in Wenzhou, China and a large multi-center critical care database from the USA. Demographic data, vital signs, laboratory values, comorbidities, and clinical outcomes were collected. The primary outcome was ICU mortality. Through multivariable logistic regression, a mortality prediction score for sepsis was developed and validated. Results Four thousand two hundred and thirty six patients in the development cohort and 8359 patients in three validation cohorts. The Prediction of Sepsis Mortality in ICU (POSMI) score included age ≥ 50 years, temperature < 37 °C, Respiratory rate > 35 breaths/min, MAP ≤ 50 mmHg, SpO2 < 90%, albumin ≤ 2 g/dL, bilirubin ≥ 0.8 mg/dL, lactate ≥ 4.2 mmol/L, BUN ≥ 21 mg/dL, mechanical ventilation, hepatic failure and metastatic cancer. In addition, the area under the receiver operating characteristic curve (AUC) for the development cohort was 0.831 (95% CI, 0.813–0.850) while the AUCs ranged from 0.798 to 0.829 in the three validation cohorts. Moreover, the POSMI score had a higher AUC than both the SOFA and APACHE IV scores. Notably, the Hosmer–Lemeshow (H–L) goodness-of-fit test results and calibration curves suggested good calibration in the development and validation cohorts. Additionally, the POSMI score still exhibited excellent discrimination and calibration following sensitivity analysis. With regard to clinical usefulness, the decision curve analysis (DCA) of POSMI showed a higher net benefit than SOFA and APACHE IV in the development cohort. Conclusion POSMI was validated to be an effective tool for predicting mortality in ICU patients with sepsis.

Comparative Analyses of the Impact of Different Criteria for Sepsis Diagnosis on Outcome in Patients with Spontaneous Subarachnoid Hemorrhage

“…In this study, we compared the impact of different criteria for sepsis diagnosis on sepsis frequencies and functional and survival outcomes in a cohort of 270 patients with an SAH. By choosing an SAH as the underlying condition of the study population, two important prerequisites for studies on sepsis criteria could be established [17,[20][21][22]: homogeneity in the underlying disease within the study population and development of infectious complications under full surveillance.…”

“…When studying sepsis criteria, two factors were identified as systematic weaknesses: first, the heterogeneity in the underlying illnesses of patients [20,21], and second, the presence of septic signs already on admission in general ICU populations, with the sepsis onset preceding the observation window of the ICU electronic health records (EHR) [17,22]. These obstacles were absent in the here analyzed SAH cohort.…”

Clinical Value of Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio in Prediction of the Development of Sepsis-Induced Kidney Injury

“…These patients have an excessive depletion of albumin as a result of a large number of inflammatory factors in the body, leading to a negative nitrogen balance, tissue hypoxia, and impaired microcirculation, thereby resulting in increased capillary permeability and a further decrease in albumin level. A previous study demonstrated that low albumin level was an effective predictor of mortality in ICU septic patients [ 33 ]. Our study determined that serum albumin (27.8, 25.10-31.30 vs. 32.60, 29.50-35.90) was significantly lower in S-AKI patients than in non-AKI patients.…”

Positive Role of Delta Neutrophil Index (DNI) as a Prodiagnostic Marker in Cecal Ligation and Puncture (CLP)-Induced Sepsis Murine Model

“…Consequently, those complex processes may be at risk of some complications, such as subcutaneous hematoma and pseudo-aneurysm after blood sampling and time spent of at least 6 h with higher cost. In addition, the greatest weakness is that from this scoring system, the prediction of sepsis and its prognosis is not feasible [ 21 ]. To compensate for this, molecular biomarkers as a non-cellular source have been introduced as early prodiagnostic markers for human sepsis, which have overcome the drawbacks of the scoring systems [ 22 ].…”